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IN 1998 when I switched from Multiple Daily Injections to an insulin pump I was having issues with fatty deposits in my abdomen from, perhaps, not doing a good enough job rotating my injection sites. These fatty deposits remain today and were blamed for poor insulin absorption and a slight rise in my A1c. I focused on better rotation and things did improve. Enter the pump. Problem solved. Or so I thought. Fast forward 14 years and it seems that I now have some scar tissue in the subcutaneous layer in my butt and sides of my abdomen. This scar tissue sometimes bends my canula upon insertion and gives me a bad site meaning poor or no insulin delivery. Damn. This is more than a small inconvenience. I am, as most of us are, extremely busy and often change my site right before leaving the house for the day. So if I am not getting delivery when I sit down to eat a few hours later it is a problem. I never bring back-up syringes or insulin because the pump really can’t be beat for reliability and convenience. My syringes are 14 years old and I think I have used 4 or 5 of them since I went on the pump. Recently, I have come to realize that I need to have back up infusion sets, insulin and syringes with me at all times and I have started to do that. Yes, this might seem like a no brainer but I find that the extra bulk in my backpack is constrictive and annoying. It is not an insurmountable problem but it is one more thing that reminds me every minute of everyday that T1 diabetes management is a walk on a tight-rope everyday. The balancing act is on-going and never-ending.

This is one of those things that crop up over the course of my T1 journey that I learn about as I go through. My medical team gives me excellent guidance but the fact that the longer I live with my “dark passenger” (to reference Dexter) the more troublesome things that seem to be happening. Not knowing, when this first happened, what was happening and why I couldn’t get my sugar down was exasperating. I don’t always have the presence of mind to call or email my medical team even though I know that they would probably know, instantly, what the issue is and how it can be resolved. This is because I feel that only I am in total control of my diabetes, so I don’t reach out for help. I’m working on that!

Another thing no one told me and in case you are not aware, a shot of cortisone for a T1 will raise your blood sugar for a relatively extended period of time and even additional insulin will not be effective in bringing it down. The one shot of cortisone that I had since being diagnosed raised my blood sugar into the high 200s to low 300s for two full weeks. I would bolus on top of bolus and nothing would bring my sugar down until one day…And then my sugar plummeted. Needless to say that experience taught me not to accept being told that a cortisone shot is the answer to my tendonitis or herniated disks. For me, it is not. I have since opted for intense physical therapy and, most recently, a PRP injection for my tendonitis. That, combined with exercise was far more effective than a cortisone injection which, I believe, masks the underlying cause of an injury anyway.

The one important lesson I have most recently learned is that the DOC – Diabetes Online Community – is one of the best things that I ever stumbled upon. I can tweet all kinds of issues or post them on Facebook and get some PWDs to chime in with their own experiences. This, to me, is one of the biggest improvements in my care since being diagnosed. Not every piece of information I get from the DOC is right for me but it does give me some ideas to try and some “thinking outside the box” thoughts and inspirations! To be able to talk directly and at length with other PWDs gives me the kind input and personal knowledge that is somehow lacking when I only deal with my doctors…

This time of year is never fun for anyone who is serious about maintaining good control over glucose. I usually give myself a couple of weeks – starting now – to loosen up the reigns a little. That is not to say I have sterling control for the other 50 weeks, I do not. I, like you and everyone else who struggles to maintain a semblance of Blood Glucose control ride the roller coaster of Life With Diabetes (LWD). A never-ending ride of peaks and valleys with a demented carnie operator who won’t stop the ride! But during this time of year the peaks and valleys get a little steeper. Crazy highs after an evening of snacking on hors’dourves that must have concentrated time released fat and sugar in them. Insane lows after treating the crazy highs and then trying to level off for a couple of days until the next stop on the December party train. It is very tiring – fun and don’t get me wrong, I really enjoy the festivities but it is exhausting all the same. I do not enjoy the extra stress of worrying about the barrage of food and drink I suddenly consume.

So this week of parties puts before me my annual preparation. I try to hit the gym every day the whole time. This year, however, I have an injured heel so the gym may not be on the radar. I still get in two 15 – 20 minute walks during the day, even though the stress on the heel is not ideal. And I will try to eat well and keep very good control on the days of the party. I also do dual wave boluses calculated to include at least 75 to 90 gms of carbs, depending on the number of roving waitstaff with platters full of trouble that seem to be around. Blood Tests – before, during and after the celebrations – there is no better way to keep tabs on things. I do not use a CGM so this is my option – close the loop and we’ll talk! I also limit my alcohol intake to 2 drinks, period. First of all, an industry party is not the place to loose control and secondly, a very drunk individual is a truly ugly and unfortunately, memorable, site! True, the drunk guy might not remember it but all of his colleagues will!

So here’s to a happy and festive journey into the dead of winter 2012 with all the sugarplums, chocolate gelt and grog you can consume and still keep your A1c in a respectable neighborhood!